Frequently Asked Questions

Who is eligible for coverage?

Any individual and their dependents who are members of the Association provided they

1.   are between the ages of 18 and 65

2.   are actively at work, performing all the normal duties of their job or, if not employed, performing the normal activities of a person of like age and gender;

3.   reside in the United States;

4.   are not in full-time service of the Armed Forces;

5.   are not receiving workers comp or disability benefits

6.   are not eligible for Medicare

Who are eligible Dependents?

Members’ dependents are also eligible. Spouses (if not legally separated or divorced) and children, including adopted and stepchildren who are unmarried and dependent on the member for support, up to age 19 (25 if a full-time student), and provided they meet the above requirements as well. Also dependents must be performing the normal duties of persons who are the same age and gender. Newborns are covered from birth provided we are notified of the birth and the appropriate premium is paid within 31 days of birth. Otherwise, the newborn is considered a late enrollee and may not be enrolled until the next open enrollment period.

When should I enroll my Dependents?
Eligible dependents must be enrolled within 31 days of the date the dependent becomes eligible (enrollment date of Member, birth or adoption).

What are the Medical Underwritting Requirements?

Med+Max policy is a guaranteed issue group policy for the members of the Association and their families. All individual and family members of the Association who satisfy the eligibility requirements listed above are automatically accepted without the need for medical questions or physical exams.

Where is the Med+Max Plan available?

The Plan is available in all 50 states.

How do I Pay for Coverage?

Monthly billings will be sent to the insured. A modal billing fee of $10.00 will be reflected on each Monthly bill. Alternatively, monthly premium may be charged to the insured’s Bank account ( EFT=electronic funds transfer). There is no modal administrative fee charged for this method of payment.

How do I enroll?

Go to,ur website www.medmaxinsurance.com, click on "Contact US", then fillout the request for information and forward it by email so that one of aour representatives can call you answer your questions and/or help enroll online if you are ready.

The annual membership dues for the association are $20 for an individual and $30 for the entire family and they are collected on the first day of January every year.

Med+Max  plans are only available for the members of the Association. There is an initial non-refundable enrollment fee of $60, there are no additional charges when you choose any of the health plans or the optional Critical Illness o RX plan.

There is an initial non- refundable enrollment fee of $25 if you enroll in the RX plan by itself.

When does coverage begin?

Eligible Members will be effective on the first day of the month following approval of the application and receipt of the first premium. Coverage is not effective on the date of the application. The effective date for the dependent of an enrolled Member will be the same as the Member’s (unless the Member adds additional dependent coverage at a later time). Only first of the month starts are available.

When does coverage end?

An insured Member’s coverage ends when the Member is no longer eligible, premiums are discontinued (subject to the grace period), when the policy terminates, Member reaches age 70, or when the Member is no longer in good standing with the  Association, whichever occurs first. Coverage on a dependent ends on the earliest date they no longer meet the definition of an eligible dependent or on the date the Member’s coverage terminates, whichever occurs first.

Can Members use any Doctor, Clinic or Hospital?

Yes. Covered members and dependents can use any licensed medical provider. OR to reduce your costs use the Multi Plan Network with over 500,000 providers in 50 states.

Are Pre-Existing Conditions covered?

Benefits under the Hospitalization or Surgery provisions of the plan are not payable for a “pre-existing condition” for the first 12 months following an insured’s effective date. If an insured has a HIPAA certificate they will be given credit for creditable coverage for the total amount of months shown on the certificate.

How Are Claims Filed?

A claim form must be completed within 90 days after the covered loss begins or as soon as it is reasonably possible. Claims are send to the address indicated in your ID card. For questions please use the number on your card.

Claims for Critical Illness benefits paid directly to the member or its beneficiary.

Claim filing instructions and forms are available online at Forms.

Med+Max is an association insurance benefit program. The insurance benefits vary depending on the plan selected. These benefits are provided under the insurance policy and are subject to the insurance company’s underwriting guidelines, exclusions, limitations, terms and conditions of coverage as set forth in the insurance policy and certificate, which includes a pre-existing limitation and other restrictions. This insurance is not basic health insurance or major medical coverage and is not designated as a substitute for basic health insurance or major medical coverage. This is a limited medical plan that provides for limitations to the coverage for each benefit. Please, review the limits of each plan.

This is a Limited Benefit Plan and may not cover all medical expenses for an illness or injury once the maximum plan payment limits per covered person, per calendar year are reached.

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